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Singapore’s rocky reopening is still a model for ending the ‘COVID zero’ era of pandemic

October 11, 2021, 12:29 PM UTC

On Saturday, Singapore Prime Minister Lee Hsien Loong announced that Singapore remains committed to fully reopening its borders as the country battles a record wave of COVID-19 infections.

“Living with COVID-19 has not been a smooth and easy journey,” Lee said in an address to the country. “[But] we must also connect ourselves back to the world. In particular, we must continue to reopen our borders safely.”

Singapore is the first among several countries in Asia to transition away from COVID zero—a policy that seeks no COVID-19 infections—to a “living with COVID” strategy that tolerates some COVID-19 cases once a vast majority of the population is fully vaccinated.

But Singapore is showing that the transition is not easy.  

Since first lifting some COVID-19 curbs in August, Singapore is now logging more than 3,000 cases per day, over three times as high as its previous peak of 1,000 in the spring of 2020. The vast majority—98.5%—of Singapore’s cases are mild or asymptomatic infections, likely thanks to Singapore’s full vaccination rate of 83%.  

But Singapore’s higher caseload is leading to more deaths. Singapore is now averaging seven COVID-19 deaths per day. In the past month, 104 people have died from COVID-19, making up nearly two-thirds of Singapore’s total death toll since the beginning of the pandemic.

In recent weeks, Singapore has delayed reopening plans and reinstated some COVID-19 curbs to battle the new wave. But Lee’s speech, along the government’s Saturday announcement that it will open quarantine-free travel for vaccinated travelers from eight countries, including the U.S., Canada, and the U.K., confirm that Singapore will remain steadfast in its pursuit of reopening its borders and its willingness to tolerate some infections and deaths.

Singapore is the first of several COVID-zero countries to announce plans to ease restrictions in coming months. And experts say that its jilted path to reopening, while flawed, provides lessons for any government trying to engineer a divergence away from an airtight COVID-19 response.

Bumpy journey

For much of 2020 and 2021, Singapore was one of Asia’s most stringent COVID-zero economies, largely sealing off its borders, instituting mass lockdowns and testing schemes when infections popped up, and implementing a swath of other social distancing measures aimed at ridding the virus completely from its soil.

Lee’s speech suggested that Singapore remains committed to reopening, a process that he says is critical to improving the economy and Singaporeans’ well-being. “Each time we tighten up, businesses are further disrupted, workers lose jobs, children are deprived of a proper childhood and school life,” he said. But his “living with COVID” pledge contrasts with lingering COVID-zero policies that continue to govern day-to-day life in the city-state.

A vaccinated American tourist, for example, soon will be able to fly to Singapore without quarantining, but won’t be able to dine with more than one companion in a restaurant there.

“The travel lanes allow Singaporeans to go out to other countries, and allow other people to come in here,” says Jeremy Lim, associate professor at the NUS Saw Swee Hock School of Public Health. “[But] if a family of four comes to Singapore they will discover that they’ve got to eat in twos and deal with all of these awkward arrangements.”

The conflicting measures are a result of Singapore’s twin COVID-19 priorities—protecting the health care system from collapse and reopening to the rest of the world.

“Singapore’s decision to reopen its borders removes the option of long-term quarantines for inbound travelers, [so] the maintenance of social distancing is the only way they have left to try to maintain a degree of disruption against the virus,” says Nicholas Thomas, a professor in global health governance at the City University of Hong Kong.

COVID zero

But Singapore’s staggered reopening can still provide a model for other highly vaccinated countries transitioning from zero tolerance to accepting some cases.

“Singapore has become the key lesson for all places that have tried to maintain a zero-COVID strategy,” owing to its early implementation of reopening plans, says Thomas.

Other COVID-zero countries like Australia and New Zealand have recently announced that they plan to ease border restrictions and eventually move away from trying to eliminate every case of COVID-19. On Monday, residents of Sydney celebrated Freedom Day, which ended months of lockdown measures in the city and kick-started a national plan to begin living with the virus.

Lim says one lesson that governments should take from Singapore is that the transition will come at a high cost.

“Countries that reopen from zero COVID to living with endemic COVID, you have to expect massive numbers [of infections] and a small proportion will die. It’s just the nature of the virus,” says Lim. “It’s a horrendously difficult message to communicate politically. But if you don’t communicate it forcefully…it can make the reopening very, very messy.”

Lim says other COVID-zero countries should be more consistent in transitioning away from zero tolerance of COVID, such as ensuring, for example, that dining restrictions align with looser border rules. “Domestic policies have to be consistent and support the international policies that are constructed,” he says.

There’s one COVID-zero country that may not be willing to learn from Singapore’s example. China, as well as the Chinese special administrative regions of Hong Kong and Macau, remain holdouts in their commitment to eliminating all COVID-19 cases.

On Monday, Hong Kong chief executive Carrie Lam stressed that Hong Kong will not tolerate a single fatality from COVID-19 and would continue to prioritize reopening the city’s border with mainland China before dropping restrictions on international travel. Mainland China, meanwhile, has shown few signs that it’s willing to reopen its international borders anytime soon.

“Asia’s recovery can only begin safely once all countries have high rates of immunization and once China reopens its borders,” says Thomas. “Neither of those is going to happen soon. My earliest guess would be another 12 months.”

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